Why It Hurts to Pee. UTI Symptoms, Causes, Treatment & Prevention

A urinary tract infection (also called a "UTI" or cystitis) is an infection of the urinary system (bladder, kidneys, ureters, and urethra) accompanied by inflammation and, often, discomfort.  

They are more common in older people and are 30% more common in women than in men (although in older age, the numbers equal out). Women have a short urethra (the tube that carries urine from the kidney to the outside). This anatomical "quirk" predisposes females to UTIs because bacteria have a shorter distance to travel to get into the female's urinary system (urethra). Because they are fairly infrequent in men, the cause in a male may be more uncertain; a healthcare provider may recommend a workup or refer the patient to a urologist.

Other factors cause the signs and symptoms of a UTI, for example, an enlarged prostate in men (please note that's prostate, not prostrate), kidney stones, a kinked ureter, yeast infections, sexually transmitted infections, and various other things. 

THE URINARY SYSTEM

Why It Hurts to Pee. UTI Symptoms, Causes, Treatment & Prevention - Symptoms of a UTI

UTIs can come on very fast or go unrecognized. A person who has never had one often has no idea what the symptoms mean: urinary burning, frequency, low back pain, and others. Sometimes, even when a person knows they have symptoms of a UTI, that person may be too busy to deal with the symptoms, so they let the symptoms go on for too long. In both of these instances, the person often becomes so sick that they end up in the ER getting IV antibiotics and fluids, and are even admitted, sometimes, for pyelonephritis (kidney infection) or septicemia - a severe illness that involves the spread of bacteria from the urinary system to the rest of the body. I see and hear about this far too often. Understanding why it hurts to pee—UTI symptoms, causes, treatment, and prevention—can help you act early and avoid serious complications.

Characteristic symptoms of a UTI are dysuria or painful urination (most common) and urinary burning or tingling before, during, and after urination. Urinary frequency, urgency (feeling a need to urinate but can't quite go), and sometimes mild pelvic discomfort occur. Urine may or may not have an odor, and it may be cloudy and occasionally a darker yellow. Less often, there may be scant blood on the toilet paper or in the urine. If the UTI is mild, drinking cranberry juice, eating blueberries, and drinking LOTS of water might help ward off worsening. But if it does not go away, it can, and sometimes does, become severe. The signs of worsening: Low back pain (flank pain - the area of the back over the kidneys), increasing low pelvic spasms (just above the pubic bone), fever, chills, nausea and vomiting, fatigue, and there may be blood in the urine or on the toilet tissue. Sometimes, older people get confused (which can be the ONLY symptom!). If any of the latter occur, the infection is becoming more serious, possibly going to the kidneys or the rest of your body (sepsis), which is extremely serious. 

If symptoms persist, a woman should speak to a healthcare provider. Usually, a urinalysis is done, and an antibiotic is prescribed if there is an infection. Sometimes, a provider sends a culture to the lab to check for a specific bacterium.

Again, women are not lucky in terms of their anatomy. The urethra is easily exposed to substances that start the UTI. And you can be the cleanest woman in the world and still get these things!

Some Common Causes of UTIs

• Bubble baths (there is little evidence of this, but it happens pretty frequently - soap irritates the urethra)

• Feminine hygiene products (irritation). In efforts to keep the perineum clean, women use feminine hygiene or cleansing products, which may increase the likelihood of getting a UTI because the cleansing agent can irritate the urethra and cause a UTI 

• Some soaps (some women are sensitive to certain kinds of soaps)

• The use of spermicidal contraceptives and vaginal lubricants

• Sexual Intercourse. Having intercourse can introduce germs from the outside of the vagina into the urethra (the urethra is at the opening of the vagina). While it may not do much for the romantic moment, women are advised to urinate before AND after intercourse.

• Failing to wipe from the front to the back (ALWAYS wipe from the front to the back; otherwise, you can get tiny "poop particles" and bacteria in your urethra).

UTI: Urinary Tract Infection

**The most common bacteria found to cause a urinary tract infection is called E. coli. This bacteria is typically found in poop (feces, stool). Although there are sometimes exceptions, this is a very frequent culprit in females because of the close proximity of the rectum to the urethra. One or two stray bacteria can travel from the rectal area to the opening of the urethra or urinary tract. The bacteria multiply, and lo and behold, a UTI develops! Side note: If you are a believer in Darwinism - evolution or natural selection - this bit of anatomy in women makes absolutely no sense.

So, what are the other causes of UTIs?

• Sitting around in wet bathing suits or sweaty panties

• Holding urine for extended periods of time (we see this a lot in teachers who cannot readily leave the classroom to go to the bathroom and in travelers who, for many reasons, do not empty their bladders when they feel the need to).

• Anything that puts pressure on the ureters (a canal that leads from the urethra to the bladder) may obstruct urine outflow and cause a UTI: Constipation, enlarged prostate (in men), pregnancy, and pelvic organ prolapse.

• Diabetes

• Anatomical anomalies (that make the "urine tubes" [ureters] narrow, kinked, for example)

• Oral sex

• Lack of hydration

• Low estrogen (as in menopause), hormones in general. Post-menopause causes dryness of the vagina and urinary tract which causes irritation which can cause infection.

• Pregnancy

• Urinary catheters

• Rectal leakage

• Tight pants/sweaty perineum - Side Note: When I was in college, I was walking down the street next to my boyfriend and his gynecologist dad. The latter pointed to a young woman in front of us and quietly said, "You see that girl? She's going to get a urinary tract infection because of her tight pants!" (Awkward - but a learning moment).

• Some patients tell me that their parents also had a history of UTIs - familial tendencies are a fact.

So, if you have a rare urinary tract infection, that's normal, but if you have two or more a year, you may consider those possible causes (above) and start changing your habits to try to rule out the culprit. You should talk to your healthcare provider if your efforts fail and you still get urinary tract infections.

Testing for a UTI

If you think you may have a UTI, you can buy a test at a retail pharmacy to perform yourself. You need to follow the instructions explicitly (method and time frame within which to read the results). Look for a change in color in the leukocytes or nitrites box: Compare it to the result boxes. If you take AZO, the color on the testing strip will be tainted orange and difficult to read.

Most leading drug stores like Walgreens, CVS, and Walmart sell these under their brands; there are also name-brand names like AZO (reputable). If you get frequent UTIs, look for a highly rated brand on Amazon so you have several tests on hand. Test on the first day of symptoms. If negative, test again on the third day. If it is still negative and you still have symptoms - and/ or av vaginal discharge or, if it seems you are getting UTIs often, consider consulting with your healthcare provider (or a urologist if you do not need a referral with your insurance).

Treatments and Possible Natural Remedies for a UTI

Please Note Regarding Over-the-Counter Treatment of UTI Symptoms:

As mentioned above, if you have symptoms of a possible UTI, you can try to treat them initially by drinking plenty of fluids, drinking cranberry juice, avoiding alcohol and caffeine, taking Azo, and decreasing your sugar intake. But whether or not you do these things, DO NOT let the symptoms go too long before speaking to a healthcare provider. Urinary tract infections can become very bad, very quickly!

Again, whatever you do, do not ignore your symptoms. If they are not going away fairly quickly or worsening despite your attempts at a cure, you need to follow up with a healthcare provider to get an antibiotic, whether in person or online.

Over-the-Counter Help for UTI Symptoms

AZO-Most of the time, over-the-counter AZO products can be very helpful in relieving urinary pain, but they do not treat the bacteria that cause the infection. Even though it helps you feel better, it MASKS the infection and can mask worsening of the infection. Here's a quick breakdown:

• AZO Standard and Max Strength contain a bladder anesthetic that eases pain and burning. These should only be used for 1–2 days (as directed) to manage discomfort before seeking treatment or during treatment, but should not be used for treatment of the infection: Only the pain.

• AZO Urinary Tract Defense claims “antibacterial prevention,” which may slow bacterial growth but doesn’t kill existing bacteria like antibiotics.

• AZO Cranberry Urinary Tract Support doesn’t kill bacteria either—it helps prevent them from sticking to the bladder wall and may be more useful for prevention, not treatment.

• Products with bladder anesthetics can mask worsening symptoms, so they should not be used long-term.

• None of these products cure a UTI—they only address symptoms. Antibiotics are still the go-to treatment for an active infection.

• One quirky side effect: AZO can turn your urine a bright orange color—totally normal!

If you use AZO, back off it after a day or two. If your symptoms remain, you should talk to a healthcare provider.

For those who get UTIs after intercourse, sometimes the use of a lubricant containing silicone is worth consideration if you have this problem.

Natural Remedies for a UTI

You can try the following herbal approaches, but if it does not seem to be working after two days or so, or if the symptoms are worsening, see a healthcare provider.

Goldenseal - Has antibacterial properties.

Dandelion - Has antibacterial properties felt to help UTIs

Garlic - Has action against E. coli - One of the most significant causes of UTIs

Nettle - Antibacterial, anti-inflammatory

Parsley - As a diuretic, it may help flush bacteria through the urinary system. It may help against specific bacteria (NOT E. coli)

Chamomile - Has anti-inflammatory and antimicrobial effects.

D-Mannose (often preventively used for frequent UTIs) - From plants, fruits, and berries (cranberries). It keeps bacteria from attaching to urinary tract walls.

Tulsi - Holy Basil - Antibacterial properties

Mallow - According to the NIH, Mallow has some urinary antibacterial properties and soothing properties 

Yarrow - Studies show some antimicrobial properties, especially against E. coli

Horseradish - Antibacterial properties, anti-inflammatory properties. German Commission e approved UTI 

*Those with frequent UTIs might consider using one or two of these herbs regularly for prevention

Prescriptive Treatments for a UTI

Still trying to get better, or are you getting worse? You need to talk to a healthcare provider about getting an antibiotic prescription. 

First-Line (best choices)

• 1. Nitrofurantoin (Macrobid)

• 2. Sulfamethoxazole/trimethoprim (Bactrim) (sulfa drug)

• 3. Fosfomycin tromethamine (Monurol) (Not often prescribed)

  
  

  Second-Line (second-best choices)

• 1. Cephalexin (Keflex)

• 2. Amoxicillin/clavulanate (Augmentin)

• 3. Ciprofloxacin (Cipro)

Good news on the frontlines of UTI treatment! The US Food and Drug Administration (FDA) recently approved pivmecillinam (Pivya) for treating urinary tract infections. Although it is not a new drug—it has been used in other countries for nearly 40 years—it is the first drug approved for UTIs in the US in 20 years! I am still waiting for pharmacies to stock this.

*The course of antibiotics for a UTI can be 1 (rare), 3, 5, 7, and 10 days, depending on the severity and the medication (this is one of the only illnesses where we base the duration of an antibiotic on the severity of illness).

*For those who frequently get UTIs after intercourse, some providers prescribe one dose of an antibiotic after sexual activity to prevent a UTI from beginning.

A Few Important Notes About UTIs:

First of all, if you have only vaginal itching, that is probably a yeast infection (talk to a pharmacist - they can recommend over-the-counter products). If that does not work, you should consider seeing a healthcare provider. A white sour-smelling vaginal discharge typically accompanies a yeast infection. Some people find that they get these when they take antibiotics. Sometimes, yeast can even cause some symptoms of a UTI.

If you have any other type of discharge and are sexually active, it is essential that you see your healthcare provider or ob-gyn. These can be sexually transmitted diseases.

Frequent bouts of blood in your urine should also be investigated by a healthcare provider- especially in older people. And, speaking of older people, sometimes, as mentioned, when they get UTIs, they have no other symptoms except the sudden onset of strange behavior/confusion. They may not have any other symptoms of a UTI. For those of you who work in long-term care, you know who these people are.

**FREQUENT UTIS IN OLDER WOMEN

Frequent UTIs are a tough affliction for some middle-aged and older women. The answer from a primary care provider will often be to "see a urologist". More often than not, the urologist does not find a problem, suspects it is your hormones, and recommends preventive measures (see herbal remedies - above) or gives you a prescription for either an antibiotic to take when you feel dysuria (uncomfortable urination) or a vaginal hormone cream like Estradiol. Some will not give you the antibiotic because of feared resistance.

Q&A: Questions??

1. Can you get an infection from a toilet seat?

There are often plenty of bacteria on a toilet seat, but people rarely contract a bacterial infection because these microorganisms do not typically live long on a toilet seat. It's more likely to happen if you have a skin lesion - a break in your skin- on your buttocks. And, by the way, catching STDs from a toilet is extremely unlikely.

By the way, can the people who leave urine droplets on the toilet seat after peeing please wipe them off? (You know who you are.)

2. What can tint your urine red?

Besides blood, some things that can make your urine red include certain foods like beets, blackberries, or rhubarb. Blood from another area, like the vagina or rectum, may make your urine red. Some medications, such as Pyridium (the medicine for UTI symptoms that can make your urine a scary orange color), sulfasalazine (Azulfidine), some Tb medications Rifampin), and pill coloring (in some constipation medications, and some vitamins) can also make your urine reddish. Dehydration and liver problems can also make your urine turn a darker red/brown color.